P1070 - Prevalence and Outcomes of Local Complications in Acute Pancreatitis: A Review of Nationwide Inpatient Data

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Shehroz Aslam, MD

Creighton University, Dignity Health St. Joseph's Medical Center
Phoenix, AZ, United States

Shehroz Aslam, MD¹, Arnold Forlemu, MD², Zaid Ansari, MD², Tanuj Sharma, MD³, Layth Al-Jashaami, MD², Sarabdeep Mann, MD², Savio Reddymasu, MBBS²
¹Creighton University, Dignity Health St. Joseph's Medical Center, Phoenix, AZ; ²Creighton University School of Medicine Phoenix Program, Phoenix, AZ; ³Creighton University/St. Joseph's Medical Center, Phoenix, AZ

Introduction: Acute pancreatitis (AP) remains a common indication for hospitalization in the digestive disease category. Local complications such as pseudocysts, pancreatic necrosis, and portal vein thrombosis might contribute to mortality and morbidity related to AP. The purpose of our study was to measure the rates of local complications related to AP and assess their impact on the health care outcomes.

Methods: We used the nationwide inpatient sample database (NIS) from 2016-2017 for this study. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for AP, AP with complications (necrosis with and without infection, pseudocyst, portal vein thrombosis, abdominal compartment syndrome) were obtained. Cox-proportional hazards regression model was used to estimate the in-hospital mortality associated with AP with and without complications, while accounting for competing events. Adjusted hazard ratios (HR) and confidence intervals (CI) at 99% were reported.

Results: The total number of patients with a diagnosis of AP was 201,891; with 25,515 (13%) having local complications related to AP. The odds of in-hospital mortality were significantly higher in AP patients with local complications compared to those without (8.4% vs 2.0%, p< 0.001). In the regression analysis, the risk of in-hospital mortality in patients with AP with complications was 3.62 times higher than in those without complications, adjusted HR 3.62, 99% CI: 3.41 – 3.83 (Table 1). In the subgroup analysis, there was no difference in in-hospital mortality in patients with a pancreatic pseudocyst (adjusted HR 1.16, 99% CI: 0.98 – 1.38). In-hospital mortality remained high in patients with pancreatic necrosis (adjusted HR 2.37, 99% CI: 2.05 – 2.75), portal vein thrombosis (adjusted HR 3.57, 99% CI: 3.34 – 3.82) and abdominal compartment syndrome (adjusted HR 20.64, 99% CI: 18.67 – 22.81). Length of stay on average was 3 days higher in patients with AP who had complications (p< 0.001) and the hospitalization related cost was higher in this group as well (greater than $54,000, p< 0.001).

Discussion: Local complications such as pseudocysts, pancreatic necrosis, and portal vein thrombosis occur in a sizeable number of patients with AP. These complications appear to be a major factor contributing to mortality and an increase in the utilization of health care resources in AP. Early detection and timely management of local complications in AP will likely improve health-related outcomes.

Parameters	In-hospital mortality; Adjusted hazard ratio (99% CI)	Hospital LOS, days; Adjusted difference (99% CI)	Total Charges $, Adjusted difference (99% CI)
Acute pancreatitis with vs without complications	3.62 (3.41 – 3.83)	3.46 (3.32 – 3.59)	54324.09 (51990.26 to 56657.91)
Age, yearly increments	1.03 (1.02 – 1.04)	0.01 (0.01 – 0.02)	131.40 (74.57 to 188.24)
Insurance status
Medicaid vs Medicare	1.09 (1.06 – 1.19)	0.23 (0.09 – 0.37)	615.51 (-1761.98 to +2993.00)
Private insurance vs Medicare	1.00 (0.92 – 1.09)	-0.19 (-0.31 to -0.06)	-48.10 (-2181.55 to +2085.36)
Self-pay vs Medicare	1.05 (0.90 – 1.20)	-0.39 (-0.59 to – 0.20)	-8564.07 (-11838.47 to -5289.67)
Other vs Medicare	0.84 (0.54 – 1.33)	-0.54 (-1.07 to -0.02)	-6409.40 (-15265.16 to +2446.37)
Race/ethnicity
Black vs White	1.22 (1.12 – 1.34)	0.03 (-0.10 to +0.16	-1999.58 (-4237.16 to +238.00)
Hispanic vs White	1.05 (0.97 – 1.14)	0.01 (-0.13 to +0.14)	17334.92 (14978.79 to 19691.06)
Asian/Pacific Islander vs White	1.39 (1.21 – 1.61)	0.47 (0.18 – 0.77)	28527.24 (23478.30 to 33576.19)
Native American vs White	1.24 (0.91 – 1.70)	-0.10 (-0.57 to +0.38)	-4036.06 (-12045.52 to +3973.40)
Sex, male vs female	1.13 (1.07 – 1.19)	0.15 (0.06 – 0.24)	3521.41 (1997.85 to 5045.00)
Median household income (ref is above 75^thpercentile)
< 25^th percentile	1.04 (0.96 – 1.14)	-0.15 (-0.28 to - 0.02)	-9243.06 (-11500.80 to -6985.31)
25^th to 50^th percentile	1.00 (0.92 – 1.09)	-0.23 (-0.36 to – 0.09)	-9912.91 ( -12201.37 to -7624.45)
51^st to 75^th percentile	0.97 (0.89 – 1.05)	-0.14 (-0.28 to – 0.00)	-5476.48 (-7817.43 to -3135.53)
Comorbidities
Diabetes	0.91 (0.66 – 1.25)	0.23 (-0.34 to + 0.80)	1531.88 (+8744.09 to -11807.84)
Coronary artery disease	0.92 (0.82 – 1.04)	0.39 (0.11 – 0.55)	4700.45 (909.33 to 8491.57)
Obesity	0.59 (0.52 – 0.67)	0.18 (0.03 – 0.34)	884.95 (1769.70 to -3539.59)
Chronic kidney disease	1.72 (1.61 – 1.84)	2.07 (1.93 – 2.22)	29237.71 (26779.08 to 31696.34)
COPD	1.08 (0.98 – 1.19)	0.25 (0.08 – 0.41)	6594.01 (3800.11 to 9387.92)
Chronic heart failure	1.50 (1.36 – 1.66)	0.93 (0.69 – 1.15)	13017.10 (9078.00 to 16956.20)
Liver cirrhosis	1.24 (1.12 – 1.38)	0.85 (0.59 – 1.11)	11561.53 (7150.55 to 15972.52)

Table: Title: Predictors of in-hospital outcomes. Footnotes: CI: confidence interval, LOS: length of stay, ref: reference, COPD: chronic obstructive pulmonary disease

Disclosures:

Shehroz Aslam indicated no relevant financial relationships.

Arnold Forlemu indicated no relevant financial relationships.

Zaid Ansari indicated no relevant financial relationships.

Tanuj Sharma indicated no relevant financial relationships.

Layth Al-Jashaami indicated no relevant financial relationships.

Sarabdeep Mann indicated no relevant financial relationships.

Savio Reddymasu indicated no relevant financial relationships.

Shehroz Aslam, MD¹, Arnold Forlemu, MD², Zaid Ansari, MD², Tanuj Sharma, MD³, Layth Al-Jashaami, MD², Sarabdeep Mann, MD², Savio Reddymasu, MBBS². P1070 - Prevalence and Outcomes of Local Complications in Acute Pancreatitis: A Review of Nationwide Inpatient Data, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.